Three-dimensional reconstruction and intraoperative ultrasonography: Crucial tools to safely approach highly complex renal masses
ABSTRACT Purpose: Robot-assisted partial nephrectomy (RAPN) is rapidly increasing its role in the nephron-sparing surgery setting (1). The recent introduction of technological advancements is leading more experienced surgeons to approach complex renal mass with a conservative intent (2, 3). In part...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Sociedade Brasileira de Urologia
2022-11-01
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| Series: | International Brazilian Journal of Urology |
| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382022000600996&tlng=en |
| _version_ | 1811220605642473472 |
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| author | Antonio Andrea Grosso Luca Lambertini Fabrizio Di Maida Maria Lucia Gallo Andrea Mari Andrea Minervini |
| author_facet | Antonio Andrea Grosso Luca Lambertini Fabrizio Di Maida Maria Lucia Gallo Andrea Mari Andrea Minervini |
| author_sort | Antonio Andrea Grosso |
| collection | DOAJ |
| description | ABSTRACT Purpose: Robot-assisted partial nephrectomy (RAPN) is rapidly increasing its role in the nephron-sparing surgery setting (1). The recent introduction of technological advancements is leading more experienced surgeons to approach complex renal mass with a conservative intent (2, 3). In particular, three-dimensional reconstruction and the use of intraoperative ultrasonography are gaining attention as crucial tools to safely and effectively approach complex cases (4, 5). We aimed to video-report the management of highly complex renal mass treated with RAPN, focusing on preoperative surgical planning and intraoperative technical nuances. Materials and methods: A 73-year-old male patient was referred to our institution for an incidental detection of a 70 mm diameter, completely endophytic, hilar renal mass (PADUA score 13, RENAL score 11a). Contrast-enhanced CT scan images were processed by M3DICS (Turin, Italy) and used to obtain a 3D virtual model. RAPN was performed by a highly experienced surgeon using Da Vinci Si robotic platform with a three-arm configuration. Results: The overall operative time was 114 min, with a warm ischemia time of 16 min. No intraoperative or postoperative complications were recorded. According to the SIB score, the pure enucleation excision strategy was performed. Histopathological analysis revealed a pT3a low-grade oncocytic kidney tumor with negative surgical margins. with negative surgical margins. At 24-months follow up, no local or systemic recurrence was detected. Conclusions: Conservative management of complex renal masses is challenging with a highly nuanced decision-making process. In this regard, preoperative 3D models and intraoperative ultrasound (US) guidance play a pivotal role to develop a tailored surgical strategy according to patient’ and tumor's characteristics. |
| first_indexed | 2024-04-12T07:44:44Z |
| format | Article |
| id | doaj.art-8926e279e7874d7499d5509b12399fe2 |
| institution | Directory Open Access Journal |
| issn | 1677-6119 |
| language | English |
| last_indexed | 2024-04-12T07:44:44Z |
| publishDate | 2022-11-01 |
| publisher | Sociedade Brasileira de Urologia |
| record_format | Article |
| series | International Brazilian Journal of Urology |
| spelling | doaj.art-8926e279e7874d7499d5509b12399fe22022-12-22T03:41:44ZengSociedade Brasileira de UrologiaInternational Brazilian Journal of Urology1677-61192022-11-0148699699710.1590/s1677-5538.ibju.2022.0224Three-dimensional reconstruction and intraoperative ultrasonography: Crucial tools to safely approach highly complex renal massesAntonio Andrea Grossohttps://orcid.org/0000-0001-5973-789XLuca LambertiniFabrizio Di MaidaMaria Lucia GalloAndrea MariAndrea MinerviniABSTRACT Purpose: Robot-assisted partial nephrectomy (RAPN) is rapidly increasing its role in the nephron-sparing surgery setting (1). The recent introduction of technological advancements is leading more experienced surgeons to approach complex renal mass with a conservative intent (2, 3). In particular, three-dimensional reconstruction and the use of intraoperative ultrasonography are gaining attention as crucial tools to safely and effectively approach complex cases (4, 5). We aimed to video-report the management of highly complex renal mass treated with RAPN, focusing on preoperative surgical planning and intraoperative technical nuances. Materials and methods: A 73-year-old male patient was referred to our institution for an incidental detection of a 70 mm diameter, completely endophytic, hilar renal mass (PADUA score 13, RENAL score 11a). Contrast-enhanced CT scan images were processed by M3DICS (Turin, Italy) and used to obtain a 3D virtual model. RAPN was performed by a highly experienced surgeon using Da Vinci Si robotic platform with a three-arm configuration. Results: The overall operative time was 114 min, with a warm ischemia time of 16 min. No intraoperative or postoperative complications were recorded. According to the SIB score, the pure enucleation excision strategy was performed. Histopathological analysis revealed a pT3a low-grade oncocytic kidney tumor with negative surgical margins. with negative surgical margins. At 24-months follow up, no local or systemic recurrence was detected. Conclusions: Conservative management of complex renal masses is challenging with a highly nuanced decision-making process. In this regard, preoperative 3D models and intraoperative ultrasound (US) guidance play a pivotal role to develop a tailored surgical strategy according to patient’ and tumor's characteristics.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382022000600996&tlng=en |
| spellingShingle | Antonio Andrea Grosso Luca Lambertini Fabrizio Di Maida Maria Lucia Gallo Andrea Mari Andrea Minervini Three-dimensional reconstruction and intraoperative ultrasonography: Crucial tools to safely approach highly complex renal masses International Brazilian Journal of Urology |
| title | Three-dimensional reconstruction and intraoperative ultrasonography: Crucial tools to safely approach highly complex renal masses |
| title_full | Three-dimensional reconstruction and intraoperative ultrasonography: Crucial tools to safely approach highly complex renal masses |
| title_fullStr | Three-dimensional reconstruction and intraoperative ultrasonography: Crucial tools to safely approach highly complex renal masses |
| title_full_unstemmed | Three-dimensional reconstruction and intraoperative ultrasonography: Crucial tools to safely approach highly complex renal masses |
| title_short | Three-dimensional reconstruction and intraoperative ultrasonography: Crucial tools to safely approach highly complex renal masses |
| title_sort | three dimensional reconstruction and intraoperative ultrasonography crucial tools to safely approach highly complex renal masses |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382022000600996&tlng=en |
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